JCO Early Release, published online ahead of print Jan 2 2008
Journal of Clinical Oncology, 10.1200/JCO.2007.13.9881
Received August 14, 2007
Accepted October 26, 2007
Short-Term Neoadjuvant Androgen Deprivation Therapy and External-Beam Radiotherapy for Locally Advanced Prostate Cancer: Long-Term Results of RTOG 8610
Mack Roach III,* Kyounghwa Bae, Joycelyn Speight, Harvey B. Wolkov, Phillip Rubin, R. Jeffrey Lee, Colleen Lawton, Richard Valicenti, David Grignon, and Miljenko V. Pilepich
From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of Statistics; and Department of Radiation Oncology, Thomas Jefferson University Hospital, Bodine Cancer Center, Philadelphia, PA; and Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.
* To whom correspondence should be addressed. E-mail: mroach{at}radonc.ucsf.edu
Purpose: Radiation Therapy Oncology Group (RTOG) 8610 was the first phase III randomized trial to evaluate neoadjuvant androgen deprivation therapy (ADT) in combination with external-beam radiotherapy (EBRT) in men with locally advanced prostate cancer. This report summarizes long-term follow-up results.
Materials and Methods: Between 1987 and 1991, 456 assessable patients (median age, 70 years) were enrolled. Eligible patients had bulky (5 times; 5 cm) tumors (T2-4) with or without pelvic lymph node involvement according to the 1988 American Joint Committee on Cancer TNM staging system. Patients received combined ADT that consisted of goserelin 3.6 mg every 4 weeks and flutamide 250 mg tid for 2 months before and concurrent with EBRT, or they received EBRT alone. Study end points included overall survival (OS), disease-specific mortality (DSM), distant metastasis (DM), disease-free survival (DFS), and biochemical failure (BF).
Results: Ten-year OS estimates (43% v 34%) and median survival times (8.7 v 7.3 years) favored ADT and EBRT, respectively; however, these differences did not reach statistical significance (P = .12). There was a statistically significant improvement in 10-year DSM (23% v 36%; P = .01), DM (35% v 47% P = .006), DFS (11% v 3%; P < .0001), and BF (65% v 80% P < .0001) with the addition of ADT, but no differences were observed in the risk of fatal cardiac events.
Conclusion: The addition of 4 months of ADT to EBRT appears to have a dramatic impact on clinically meaningful end points in men with locally advanced disease with no statistically significant impact on the risk of fatal cardiac events.
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